FCCS: Fundamentals of Critical Care Support Exam Review | Complete Study Guide with Questions and Verified Answers| 100% Correct (Latest 2023/ 2024 Update) Grade A Guaranteed

FCCS: Fundamentals of Critical Care Support Exam Review | Complete Study Guide with Questions and Verified Answers| 100% Correct (Latest 2023/ 2024 Update) Grade A Guaranteed Q: NPPV uses two levels of positive airway pressure, combining modalities of pressure support ventilation and what? Answer: CPAP Q: What is CPAP? Answer: continuous positive airway pressure - Allows spontaneous breathing from a gas source at an elevated baseline system pressure (higher than atmospheric pressure) - Functionally equivalent to PEEP. Q: By convention, PSV mode is referred to as and CPAP is referred to as when talking about NPPV/BIPAP Answer: PSV = IPAP CPAP = EPAP The difference between these two numbers determines the tidal volume generated. Q: Initiation of NPPV guidelines Answer: - Do not delay intubation if needed and keep in mind the patient's resuscitation status. - Consider ABG analysis prior to initiation. - Explain the procedure. - Keep head of bed at e45°. - Ensure appropriate mask or helmet size. - Assess the patient's tolerance of the mask by applying it by hand before securing the harness. - Adjust the difference between EPAP and IPAP to achieve and effective VT and CO2 clearance. Adjust EPAP for alveolar recruitment in increments of 2 cm H2O per step to improve oxygenation. Depending on the ventilator, a similar increase in IPAP may be required to maintain the same VT. - If assist-control volume ventilation is used, begin with a VT of 6 to 8 mL/kg (depending on the underlying pulmonary condition). - Titrate pressures, volume, and FIO2 to achieve appropriate pH, PaO2, and PaCO2 levels. Ventilator changes can be made every 15 to 30 minutes. - Follow vital signs, pulse oximetry, mental status, clinical appearance, and ABG (if indicated). - Remember that goals of NPPV may include a respiratory rate <30 breaths/min, VT >7 mL/kg of predicted body weight, improved gas exchange, and patient comfort. - It is also important to be cognizant that IPAP > 20 cm H2O may lead to gastric distension. Q: What are the goals of NPPV? Answer: The goals of NPPV may include a - respiratory rate <30 breaths/min - VT >7 mL/kg of predicted body weight - improved gas exchange - patient comfort. Q: Initial NPPV settings Answer: Use the following initial ventilator settings: - Mode: Spontaneous - Trigger: Maximum sensitivity - FIO2: 1.00 - (PEEP) EPAP: 4-5 cm H2O ** (higher levels are poorly tolerated initially) - (PSV) IPAP: 10-15 cm H2O - Backup rate: Start at 6/min Q: CPAP indications, pros, cons Answer: - CPAP alone can also be delivered noninva- sively but does not provide support of ventilation. - CPAP allows spontaneous breathing from a gas source at an elevated baseline system pressure (higher than atmospheric pressure) and is functionally equivalent to positive end-expiratory pressure (PEEP). - uncomfy - primarily used to treat OSA Q: *DRUGS USED TO FACILITATE TRACHEAL INTUBATION* - Fentanyl Dose : Benefits: Cautions: Answer: *Fentanyl* Dose: 0.5-2ug/kg IV bolus every several minutes, titrated for analgesia. Benefits: Rapid onset, short acting, reversible w/ naloxone Cautions: chest wall rigidity w/ rapid administration, respiratory depression, does not inhibit awareness of procedure Q: *DRUGS USED TO FACILITATE TRACHEAL INTUBATION* - Midazolam Dose: Benefits: Cautions: Answer: *Midazolam* Dose: 0.1-0.3mg/kg bolus, titrated to sedate Benefits: Provides amnesia, rapid onset, short acting, reversible w/ fumazenil Cautions: Added respiratory depression when combined w/ narcotics Q: *DRUGS USED TO FACILITATE TRACHEAL INTUBATION* - Etomidate Dose:Benefits: Cautions Answer: *Etomidate* Dose: 0.1-0.3mg/kg single IV bolus Benefits: provides hypnosis, MAY be preferred in head injury, NO adverse CV effects Cautions: May induce myoclonus including mild trismus (consider pre-medicating w/ fentanyl), NO reversal agent, transient adrenal suppression Q: *DRUGS USED TO FACILITATE TRACHEAL INTUBATION* - Lidocaine Dose:Benefits: Cautions Answer: *Lidocaine* Dose: 1-1.5mg/kg IV bolus 2-3 min before laryngoscopy Benefits: blunts hemodynamic and tracheal response to intubation, may reduce ICP during laryngoscopy Cautions: should not exceed 4mg/kg due to neurotoxicity (seizures) Q: *DRUGS USED TO FACILITATE TRACHEAL INTUBATION* - Ketamine Dose:Benefits: Cautions Answer: *Ketamine* Dose: 1-4mg/kg IV bolus Benefits: Rapid onset, no adverse CV effects (exception in severe CHF), short acting Cautions: May increase ICP, hallucinations, consider a small dose of benzo like midazolam as an adjunct. Q: *DRUGS USED TO FACILITATE TRACHEAL INTUBATION* - Propofol Dose:Benefits: Cautions Answer: *Propofol* Dose: 1-2mg/kg IV bolus Benefits: rapid onset, short acting, provides amnesia